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Pathophys II MHM - Exam 3 > Neuro Module 3 > Flashcards

Neuro Module 3 Flashcards

1
Q

What does the diencephalon consist of?

A
  • Epithalamus
  • Subthalamus
  • Hypothalamus
  • Thalamus
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2
Q

What is the thalamus and what does it do?

A
  • Gateway to the cortex

- Relays sensory input to cortex (EXCEPT CN 1)

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3
Q

Describe sensory input to the thalamus

A

ALL sensory must pass through thalamus (EXCEPT CN 1)

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4
Q

How does motor info pass through the thalamus?

A

Via basal ganglia

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5
Q

How does the limbic system relate to the thalamus?

A

Limbic connects to thalamus

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6
Q

Describe output from the thalamus

A
  • Most fibers project to the cortex (some to limbic areas and basal ganglia)
  • Somatosensory input to the thalamus “enters consciousness”
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7
Q

Anatomy of the thalamus

A
  • Oval shaped cluster of nuclei

- Comprises 80% of diencephalon

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8
Q

Nuclei functions of the thalamus

A
  1. RELAY NUCLEI - send specific info to a certain location in cortex
  2. ASSOCIATION NUCLEI - regulatory inputs from cortex project to these nuclei which project back to cortex
  3. INTRALAMINAR and MIDLINE NUCLEI - basal ganglia and limbic system project to these which go back to cortex
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9
Q

Define central pain

A

Sensation of pain (nociception) that originates in CNS

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10
Q

Define peripheral pain

A

Sensation of pain that originates in peripheral nerve

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11
Q

Define thalamic pain

A

Light somatosensory stimulus (or none at all) generate pain sensation due to thalamic damage (posterior)

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12
Q

Thalamic pain syndrome

A
  • Caused by thalamic stroke in posterior thalamus
  • Pain and loss of sensation
  • AKA Dejerine-Roussy, Posterior Thalamic syndromes
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13
Q

What is the internal capsule?

A
  • Bundle of fibers (white matter) located between thalamus/caudate nucleus and lenticular nucleus
  • Almost all neural connections pass to/from the cortex through the internal capsule
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14
Q

Function of the internal capsule?

A

Almost all neural connections pass to/from the cortex through internal capsule

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15
Q

What is corona radiata?

A
  • Part of internal capsule

- Broad expanse of white matter spanning up and out to the cortex

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16
Q

5 parts of the internal capsule

A
  1. Anterior limb
  2. Genu
  3. Posterior limb
  4. Retrolenticular part
  5. Sublenticular part
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17
Q

Posterior limb of internal capsule contains:

A
  • Thalamus to cortex pathway
  • Corticospinal and cotricobulbar tracts
  • VPL (input from body)/VPM (input from face) of thalamus project somatosensory fibers up to somatosensory cortex
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18
Q

What is the genu of the internal capsule?

A

Transition area between anterior and posterior limbs

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19
Q

Retrolenticular part of internal capsule contains:

A

Fibers connecting thalamus to posterior lobes of cerebral cortex including:
-Optic radiation (thalamus to visual cortex)

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20
Q

Sublenticular part of internal capsule contains:

A
  • Some fibers of optic radiation (like retrolenticular part)

- Auditory radiation (thalamus to auditory cortex)

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21
Q

What is a lacunar stroke?

A

“Small vessel stroke”
Blood supply to internal capsule:
-Lenticulostriate arteries of MCA
-Perforating arteries of ACA

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22
Q

Pathology of lacunar stroke

A
  • Micro deposits of CT or fatty tissue

- Necrotic tissue is then removed by macrophages leaving “holes” (for a few months)

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23
Q

What is the MC form of lacunar stroke?

A

Pure motor

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24
Q

Pure motor stroke

A
  • MC form of lacunar stroke
  • Posterior limb of internal capsule
  • Contralateral hemiparesis/plegia
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25
Q

Types of lacunar stroke

A
  1. Pure motor
  2. Ataxic hemiparesis
  3. Mixed motor and sensory
  4. Pure sensory
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26
Q

Ataxic hemiparesis lacunar stroke

A
  • Pons, posterior internal capsule and other areas
  • Site of lesion includes cerebellar AND motor pathways
  • Homolateral ataxia and crural paresis
  • Leg symptoms more than arms
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27
Q

Mixed motor and sensory lacunar stroke

A
  • Infarct of posterior limb and thalamus

- Contralateral hemiparesis/paresthesia

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28
Q

Pure sensory lacunar stroke

A
  • Least common type

- Lacunar stroke in thalamus

29
Q

Define basal ganglia

A

Group of nuclei located bilaterally deep in telenchephalon, diencephalon, midbrain

30
Q

Function of basal ganglia

A

Modify motor control (initiation and execution of)

31
Q

5 major nuclei of basal ganglia

A
  • Putamen
  • Caudate nucleus
  • Nucleus accumbens
  • Globus pallidus
  • Other: substantia nigra (midbrain), subthalamus (diencephalon)
32
Q

How are basal ganglia classified?

A
  • Lentiform nuclei (putamen and globus pallidus)
  • Striatum (putamen, caudate nucleus and nucleus accumbens)
  • Corpus striatum (all 3 - putamen, globus pallidus, caudate nucleus)
33
Q

What do the basal ganglia stimulate the thalamus to do?

A

Either increase or decrease thalamic drive to the motor cortex

34
Q

What happens with too much thalamic drive to motor cortex?

A

Excessive unwanted movement (hyperkinesis)

35
Q

What happens with too little thalamic drive to motor cortex?

A

Not enough movement (hypokinetic)

36
Q

Basal ganglia normal tone is:

A

Inhibition to thalamus

37
Q

What does sum total direct and indirect pathways of basal ganglia determine?

A

Amount of thalamic inhibition

38
Q

Direct pathway of basal ganglia

A

Cortex - striatum - GP - SNr - thalamus - cortex

39
Q

Function of basal ganglia direct pathway

A
  • Decreases inhibition
  • Results in HIGH thalamic drive
  • Facilitates movements
40
Q

Indirect pathway of basal ganglia

A

Cortex - striatum - GP - STh - GP - thalamus - cortex

41
Q

Function of basal ganglia indirect pathway

A
  • Increases inhibition
  • Results in LOW thalamic drive
  • Blocks unwanted movements
42
Q

Hypokinetic movement disorders

A
  • Absence or difficulty w/intended movements

- Bradykinesia and rigidity

43
Q

Hyperkinetic movement disorders

A
  • Extraneous unwanted movements

- Chorea, athetosis, ballismus

44
Q

Disorders of basal ganglia are classified as:

A

Hyper or hypokinetic

45
Q

Define chorea

A

Involuntary, constant, rapid, complex body movements that flow from one part to another

46
Q

Define choreiform

A

Resembling chorea (involuntary dance like movement of limbs)

47
Q

Define athetosis

A

Slow, writhing movements of fingers and hands (sometimes toes)

48
Q

Define ballismus

A

Violent, flailing movements

49
Q

What causes hemiballismus?

A

Damage to subthalamic nuclei of basal ganglia

50
Q

Define dystonia

A

Persistent spasm/posture of a body part which can result in grotesque movements and distorted positions of the body

51
Q

Define tremor

A

Rhythmic, involuntary, oscillatory movements

52
Q

Resting vs. postural tremor

A
  • Resting tremor decreases with activity

- Postural increases with action

53
Q

Essential tremor

A
  • MC form
  • Occurs in a person who is moving or trying to move
  • Familial, no cause identified
  • Worsened by stress, fatigue, fear, anger, caffeine, cigs
54
Q

What is the MC form of tremor?

A

Essential

55
Q

What is a common cause intentional tremor?

A

Cerebellar pathology

56
Q

Define bradykinesia

A

Slowing of voluntary movement

57
Q

Define lead-pipe rigidity

A

Increased muscle tone (resistance) persists through ROM of a particular joint

58
Q

Define cogwheel rigidity

A

Periodic muscle resistance at different points throughout ROM

59
Q

Rigidity vs. spasticity

A
  • Spasticity is speed dependent (moving slow can move limb through ROM)
  • Rigidity is NOT influenced by speed (moving fast or slow but still can’t move through ROM)
60
Q

Describe Parkinson’s

A
  • Hypokinetic disorder
  • Increased rigidity, resting tremor
  • Destruction of substantia nigra (reduced dopamine production)
  • Decreased thalamic drive to motor cortex
61
Q

Causes of Parkinson’s

A
  • Genetic

- Environmental (pesticides, MPTP, trauma like boxing)

62
Q

Describe Huntington’s

A
  • Hyperkinetic disorder
  • Choreiform movement, dementia, behavior changes
  • Onset at middle age
  • Increased thalamic drive to motor cortex
63
Q

Pathology of Parkinson’s

A

-Inhibits DIRECT pathway
-Allows INDIRECT to dominate
(Decreased thalamic drive)

64
Q

Pathology of Huntington’s

A

-Inhibits INDIRECT pathway

Increased thalamic drive to cortex

65
Q

Define tardive dyskinesia

A
  • Delayed onset of symptoms
  • Dyskinesia w/involuntary uncontrollable movements
  • Mouth, tongue, trunk, limbs
66
Q

What causes tardive dyskinesia ?

A

Side effect of prolonged use of antipsychotics or dopamine antagonists

67
Q

Define tic

A

Rapid and repeated and stereotyped involuntary movements

68
Q

Tourette’s syndrome

A
  • Hyperkinetic
  • Motor and vocal tics
  • Pathology not completely understood (elevated dopamine considered significant)
69
Q

Criteria to diagnose Tourette’s syndrome?

A
  • Presence of both motor and vocal tics
  • Multiple tics nearly every day through a period of more than 1 year and w/o a remission of tics for greater than 3 consecutive months
  • Symptoms cause distress or impairment in functioning
  • Age of onset less than 18
  • Symptoms not due to meds or drugs or other medical condition

Pathophys II MHM - Exam 3 (5 decks)

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